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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200792
Report Date: 06/11/2024
Date Signed: 06/11/2024 10:21:43 AM


Document Has Been Signed on 06/11/2024 10:21 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:APPLEWOOD RESIDENCE LLCFACILITY NUMBER:
079200792
ADMINISTRATOR:ARACELI S. EMERICKFACILITY TYPE:
740
ADDRESS:5123 ESMOND AVETELEPHONE:
(650) 722-2381
CITY:RICHMONDSTATE: CAZIP CODE:
94805
CAPACITY:6CENSUS: 0DATE:
06/11/2024
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Araceli Emerick, AdministratorTIME COMPLETED:
10:30 AM
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On 06/10/24 around 09:20 AM, L. Holmes Licensing Program Analyst (LPA) arrived announced to conduct a case management for the facility closure. LPA met with Administrator, Araceli Emerick (ADM).

LPA received a closure notice from ADM dated 05/16/24 that effective 07/20/24 the facility would close and a list of residents was provided to CCLD and where they were relocated. LPA and ADM inspected the facility inside and out including but not limited to three (3) bedrooms, one (1) bathroom, kitchen, dining area, living area, staff room and all other common areas. There were not any residents observed at the facility. Licensee states that the residents have relocated to Rosewood Residence. The facility’s license was surrendered to LPA during the visit.

Exit interview conducted and a copy of this report was provided to ADM.
SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Lisha HolmesTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/11/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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